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• Journal article
  Graham NSN, Cole JH, Bourke NJ, Schott JM, Sharp DJet al., 2023,

  Distinct patterns of neurodegeneration after TBI and in Alzheimer's disease

  , Alzheimer's and Dementia, Vol: 19, Pages: 3065-3077, ISSN: 1552-5260

  IntroductionTraumatic brain injury (TBI) is a dementia risk factor, with Alzheimer's disease (AD) more common following injury. Patterns of neurodegeneration produced by TBI can be compared to AD and aging using volumetric MRI.MethodsA total of 55 patients after moderate to severe TBI (median age 40), 45 with AD (median age 69), and 61 healthy volunteers underwent magnetic resonance imaging over 2 years. Atrophy patterns were compared.ResultsAD patients had markedly lower baseline volumes. TBI was associated with increased white matter (WM) atrophy, particularly involving corticospinal tracts and callosum, whereas AD rates were increased across white and gray matter (GM). Subcortical WM loss was shared in AD/TBI, but deep WM atrophy was TBI-specific and cortical atrophy AD-specific. Post-TBI atrophy patterns were distinct from aging, which resembled AD.DiscussionPost-traumatic neurodegeneration 1.9–4.0 years (median) following moderate-severe TBI is distinct from aging/AD, predominantly involving central WM. This likely reflects distributions of axonal injury, a neurodegeneration trigger.HighlightsWe compared patterns of brain atrophy longitudinally after moderate to severe TBI in late-onset AD and healthy aging.Patients after TBI had abnormal brain atrophy involving the corpus callosum and other WM tracts, including corticospinal tracts, in a pattern that was specific and distinct from AD and aging.This pattern is reminiscent of axonal injury following TBI, and atrophy rates were predicted by the extent of axonal injury on diffusion tensor imaging, supporting a relationship between early axonal damage and chronic neurodegeneration.

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• Journal article
  Parkinson M, Dani M, Fertleman M, Soreq E, Barnaghi P, Sharp D, Li LMet al., 2023,

  Using home monitoring technology to study the effects of traumatic brain Injury in older multimorbid adults: protocol for a feasibility study

  , BMJ Open, Vol: 13, ISSN: 2044-6055

  Introduction:The prevalence of Traumatic Brain Injury (TBI) among older adults is increasing exponentially. The sequelae can be severe in older adults and interacts with age-related conditions such a multimorbidity. Despite this, TBI research in older adults, is sparse. Minder, an in-home monitoring system using developed by the UK DRI Centre for Care Research and Technology, uses infra-red sensors and a bed mat to passively collect sleep and activity data. Similar systems have been used to monitor the health of older adults living with dementia. We will assess the feasibility of using this system to study changes in the health status of older adults in the early period post TBI.Methods and analysis:The study will recruit 15 inpatients (>60 years) with a moderate-severe TBI, who will have their daily activity and sleep patterns monitored using passive and wearable sensors over 6 months. Participants will report on their health during weekly calls, which will be used to validate sensor data. Physical, functional, and cognitive assessments will be conducted across the duration of the study. Activity levels and sleep patterns derived from sensor data will be calculated and visualised using activity maps. Within participant analysis will be performed to determine if participants are deviating from their own routines. We will apply machine learning approaches to activity and sleep data to assess whether these changes in these data can predict clinical events. Qualitative analysis of interviews conducted with participants, carers, and clinical staff will assess acceptability and utility of the system.Ethics and dissemination:Ethical approval for this study has been granted by the London - Camberwell St Giles Research Ethics Committee (REC number: 17/LO/2066). Results will be submitted for publication in peer review journals, presented at conferences and inform the design of a larger trial assessing recovery after TBI.

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• Journal article
  Su T, Calvo RA, Jouaiti M, Daniels S, Kirby P, Dijk D-J, Della Monica C, Vaidyanathan Ret al., 2023,

  Assessing a sleep interviewing chatbot to improve subjective and objective sleep: protocol for an observational feasibility study

  , JMIR Research Protocols, Vol: 12, Pages: 1-10, ISSN: 1929-0748

  BACKGROUND: Sleep disorders are common among the aging population and people with neurodegenerative diseases. Sleep disorders have a strong bidirectional relationship with neurodegenerative diseases, where they accelerate and worsen one another. Although one-to-one individual cognitive behavioral interventions (conducted in-person or on the internet) have shown promise for significant improvements in sleep efficiency among adults, many may experience difficulties accessing interventions with sleep specialists, psychiatrists, or psychologists. Therefore, delivering sleep intervention through an automated chatbot platform may be an effective strategy to increase the accessibility and reach of sleep disorder intervention among the aging population and people with neurodegenerative diseases. OBJECTIVE: This work aims to (1) determine the feasibility and usability of an automated chatbot (named MotivSleep) that conducts sleep interviews to encourage the aging population to report behaviors that may affect their sleep, followed by providing personalized recommendations for better sleep based on participants' self-reported behaviors; (2) assess the self-reported sleep assessment changes before, during, and after using our automated sleep disturbance intervention chatbot; (3) assess the changes in objective sleep assessment recorded by a sleep tracking device before, during, and after using the automated chatbot MotivSleep. METHODS: We will recruit 30 older adult participants from West London for this pilot study. Each participant will have a sleep analyzer installed under their mattress. This contactless sleep monitoring device passively records movements, heart rate, and breathing rate while participants are in bed. In addition, each participant will use our proposed chatbot MotivSleep, accessible on WhatsApp, to describe their sleep and behaviors related to their sleep and receive personalized recommendations for better sleep tailored to their specific reasons for disrup

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• Journal article
  Del Giovane M, Trender WR, Bălăeţ M, Mallas E-J, Jolly AE, Bourke NJ, Zimmermann K, Graham NSN, Lai H, Losty EJF, Oiarbide GA, Hellyer PJ, Faiman I, Daniels SJC, Batey P, Harrison M, Giunchiglia V, Kolanko MA, David MCB, Li LM, Demarchi C, Friedland D, Sharp DJ, Hampshire Aet al., 2023,

  Computerised cognitive assessment in patients with traumatic brain injury: an observational study of feasibility and sensitivity relative to established clinical scales

  , EClinicalMedicine, Vol: 59, ISSN: 2589-5370

  Background:Online technology could potentially revolutionise how patients are cognitively assessed and monitored. However, it remains unclear whether assessments conducted remotely can match established pen-and-paper neuropsychological tests in terms of sensitivity and specificity.Methods:This observational study aimed to optimise an online cognitive assessment for use in traumatic brain injury (TBI) clinics. The tertiary referral clinic in which this tool has been clinically implemented typically sees patients a minimum of 6 months post-injury in the chronic phase. Between March and August 2019, we conducted a cross-group, cross-device and factor analyses at the St. Mary’s Hospital TBI clinic and major trauma wards at Imperial College NHS trust and St. George’s Hospital in London (UK), to identify a battery of tasks that assess aspects of cognition affected by TBI. Between September 2019 and February 2020, we evaluated the online battery against standard face-to-face neuropsychological tests at the Imperial College London research centre. Canonical Correlation Analysis (CCA) determined the shared variance between the online battery and standard neuropsychological tests. Finally, between October 2020 and December 2021, the tests were integrated into a framework that automatically generates a results report where patients’ performance is compared to a large normative dataset. We piloted this as a practical tool to be used under supervised and unsupervised conditions at the St. Mary’s Hospital TBI clinic in London (UK).Findings:The online assessment discriminated processing-speed, visual-attention, working-memory, and executive-function deficits in TBI. CCA identified two significant modes indicating shared variance with standard neuropsychological tests (r = 0.86, p < 0.001 and r = 0.81, p = 0.02). Sensitivity to cognitive deficits after TBI was evident in the TBI clinic setting under supervised and unsupervised conditions (F (15,555) = 3.9

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• Journal article
  Kirby P, Lai H, Horrocks S, Harrison M, Wilson D, Daniels S, Calvo RA, Sharp DJ, Alexander CMet al., 2023,

  Patient and public involvement in technology-related dementia research: a scoping review (Preprint)

  , JMIR Aging, Vol: 7, ISSN: 2561-7605

  Background:Technology-related research for people with dementia and their carers often aims to enable people to remain living at home for longer and to prevent unnecessary hospital admissions. To develop research that is person-centred, effective and ethical, patient and public involvement (PPI) is necessary, though may be perceived as more difficult with this cohort. With recent and rapid expansions in health and care related technology, this review explores how, and with what impact, collaborations between researchers and stakeholders such as people with dementia have taken place.Objective:To describe approaches to PPI used to date in technology-related dementia research, along with the barriers and facilitators and impact of PPI in this area.Methods:A scoping review of literature relating to dementia, technology and patient and public involvement was conducted using Medline, PsycINFO, EMBASE and CINAHL. Papers were screened for inclusion by two authors. Data was then extracted using a pre-designed data extraction table by the same two authors; a third author supported resolution of any conflicts at each stage. Barriers and facilitators of undertaking PPI were then examined and themed.Results:Thirty-one papers were included for analysis. The majority (21/31) did not make clear distinctions between activities undertaken as PPI and activities undertaken by research participants, and as such their involvement did not fit easily into the NIHR definition of PPI. Most of this mixed involvement focused on the reviewing or evaluating of technology prototypes. A range of approaches was described, most typically using focus groups or co-design workshops. Nine studies described involvement at multiple stages through the research cycle, sometimes with evidence of sharing of decision-making power. Some studies commented on barriers or facilitators to effective PPI. Challenges identified were often around issues of working with people with significant cognitive impairments, and

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